Dysphagia

Question 1

Where does the oesophagus begin?

Answer 1

inferior pharyngeal constrictor merges with the cricopharygeus

Question 2

How long is an oesophagus?

Answer 2

18-26cm

Question 3

Where are there indentations in the oesophagus?

Answer 3

aortic arch
diaphragmatic hiatus
anterior body of C7

Question 4

What causes odynophagia?

Answer 4

infection

tablets

Question 5

If there is a problem with primarily solids, what tends to be the reason?

Answer 5

structural lesion like a malignancy or peptic stricture

Question 6

If there is a problem with swallowing both solids and liquids what is more likely?

Answer 6

motility disorder like achalasia or scleroderma

Question 7

What are the investigations carried out in dysphagia?

Answer 7

OGD and biopsy

Question 8

What medications can cause dysphagia?

Answer 8

antipsychotics (dopamine blockers)
tricyclic antidepressants (anticholinergic)
opioids (increase lower oesophageal contractility)
calcium channel blockers (smooth muscle relaxation)

Question 9

What is the normal lumen of the oesophagus?

Answer 9

20mm

Question 10

When does dyspahgia become a problem when the lumen of the oespophagus is smaller?

Answer 10

<15mm

Question 11

What are some benign strictures causing dysphagia?

Answer 11

schatki rings
caustic strictures
peptic strictures
anastomotic
radiation induced
oesophageal webs

Question 12

What is achalasia?

Answer 12

insufficient LOS relaxation

loss of oesophageal peristalsis

Question 13

Why can achalasia occur?

Answer 13

loss of ganglion cells in the myenteric plexus

infiltrate of T lymphocytes, eosinophils and mast cells

Question 14

What are the symtpoms of achalasia?

Answer 14

dysphagia of solids and liquids
regurgitation
chest pain

Question 15

How is achalasia diagnosed?

Answer 15

barium oesophagram with fluroscopy

Question 16

What is seen on the barium swallow in achalasia?

Answer 16

oesophageal dilatation
closed LOD
loss of peristalsis
bird’s beak

Question 17

How is the functional obstruction relieved of the distal oesophagus?

Answer 17

pharmacotherapy
botulinum toxin
oesophageal dilation

Question 18

What is eosinophilic oesophagitis?

Answer 18

inflammatory disorder of the oesophagus

accumulation of eosinophils

Question 19

How is eosinophilic oesophagitis diagnosed?

Answer 19

biopsy

Question 20

Who does eosinophilic oesophagitis normally affect?

Answer 20

young males, intermittently

dysphagia to solids

Question 21

What is eosinophilic oesophagitis treatment?

Answer 21

PPI
swallowed steroids
elimination diet (gluten/dairy/eggs/nuts/fish)
endoscopic dilation

Question 22

Where are squamous cell carcinomas found in comparison to adenocarcinomas in the oesophagus?

Answer 22

squamous - upper

adeno - lower

Question 23

What are the risk factors for squamous cell oesophageal carcinoma?

Answer 23

smoking

asian

Question 24

What are the risk factors for adenocarcinoma of the oesophagus?

Answer 24

western lifestule
GORD
BArrett’s oesophagus

Question 25

What is the treatment for SSC and adeno of the oesophagus?

Answer 25

surgery

chemoradiation

Question 26

How is oesophageal cancer diagnosed?

Answer 26

endoscopy

staged by CTCAP and PET scan

Question 27

What are the surgical interventions for oesophageal cancer?

Answer 27

stenting
multiband mucosectomy (EMR)